[Hemorrhoids. On the evaluation of different surgical procedures]

The spectrum of procedures for haemorrhoidal disease can deal with all developmental stages if done in a differentiated way. The possibilities, limitations, and risks of the different methods are described. The catalogue stretches from relatively simple operations (Milligan-Morgan, stapler haemorrhoidectomy), which every general surgeon should be able to perform, to extensive anoplastic reconstruction, which is limited to specialists. Although the global risks of the more simple operations make them suitable for outpatient procedures, there are--at least in Germany--severe reservations, as there is the danger of inadequately therapy in more advanced cases, overcharging a lot of patients, lack of cooperation and knowledge about the necessities of early postoperative care by the local practitioners, problems in follow-up in patients living far away, and inadequate payment for the therapeutical costs by the health insurance companies.